Jeremy Heywood - an appreciation

Why he mattered: Lord Heywood of Whitehall retired from his job as cabinet secretary in October last year and died two weeks later. He had spent two decades at the heart of government; beginning as principal private secretary to both Tony Blair and, then, Gordon Brown. In 2010 David Cameron made him the first Downing Street permanent secretary. He became cabinet secretary – the civil service’s top job – in 2012.

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Jeremy Heywood appeared as regular as clockwork in the top 10 of the annual HSJ100 list of the most powerful people in health policy. Yet that was often the only time we mentioned him all year. His influence on almost all the major health policy decisions of the last two decades was profound but shrouded in the secrecy of the senior civil service. Now some of that story can be told with the aid of those who knew and worked alongside him.

One person who has good reason to remember him fondly is NHS England chief executive – and former No10 colleague – Simon Stevens.

Sir Jeremy (as he was then) was diagnosed with lung cancer in 2017 and took a leave of absence in June 2018 as the treatment ratcheted up. That, however, did not stop him continuing to work and influence.

Phoning and texting from his hospital bed he helped ensure the £20.5bn promised by the PM was duly delivered in last autumn’s budget.

“Even on days when Jeremy was in hospital undergoing some deeply unpleasant procedures, he was in touch,” remembers Mr Stevens. “He was an important part of getting last summer’s 70th birthday deal done.”

Intellectual power

Lord Ara Darzi – who got to know Lord Heywood when the surgeon was appointed a government minister in 2006 – spent many hours by his bedside. He found a man who “still had a great clarity of mind [and] was contributing in great detail [to government business] with the same intellectual power up to almost the very end”.

These contributions included keeping an eye on NHS performance and the attempts to shore up waiting times. Despite his illness, he developed a close relationship with the national emergency care director, Dame Pauline Philip. This “pretty unusual arrangement” helped both NHS and government navigate the awful winter of 2017-18.

But Lord Heywood’s efforts while ill were far from the first time the service had caused to be thankful to the cabinet secretary, claims the NHS England chief: “Over the last several years when we’ve needed to get some big decisions landed in government, including [during] the big political transitions, Jeremy was always an ally, not just personally, but for the NHS too.”

Another senior NHS figure believes it would have been “much harder to win the funding arguments” the NHS had put forward during this decade without Lord Heywood’s support. However, they suggest his most valuable contribution was to explain NHS reform to the prime minister and others at the centre of government.

“Without him,” they remark, “a lot more time would have been spent fending off daft ideas about what the NHS should look like. He could illustrate discreetly why they were ill-advised or counterproductive.”

Mental health champion

But it was perhaps mental health where Lord Heywood made the greatest contribution.

Jeremy Clarke first met his namesake while still at school. Their friendship blossomed at Oxford University and continued into adulthood. The Clarke and Heywood families would often holiday together.

While Jeremy H rapidly rose through the civil service, Jeremy C became a psychotherapist.

Fast forward to the third term of New Labour and Jeremy Clarke is working with Richard Layard to convince the government of the economic case for investing in mental health. After initial interest, prime minister Gordon Brown was spooked by infighting within the psychiatry profession and Mr Clarke turned to his friend for help.

Sir Jeremy commissioned a paper from Professor Layard and then convened a meeting with the idea’s proponents and Treasury officials. After they had made the case, Professor Layard and Clarke left the room and nervously waited for the verdict. “What happened?” they asked when the prime minister’s PPS emerged. “Good news,” he exclaimed, “they didn’t say ‘no’”.

A little while later the government invested £300m in widening access to talking therapies.

Jeremy Clarke claims that it was his friend who told Jeremy Hunt: “You need to get a better handle on mental health”

Lord Heywood was also instrumental in the dramatic increase in the profile of the sector which began towards the end of David Cameron’s time as PM and continued when Theresa May took over. He took personal responsibility for leading work across departments, making sure progress continued when political focus wavered.

Mr Cameron’s senior health adviser from 2013 to 2016, Nick Seddon, declares that “he had a transformative impact on how much more seriously mental health and dementia were taken across government”.

Jeremy Clarke claims that it was his friend who told Jeremy Hunt: “You need to get a better handle on mental health.”

‘Holy f***, how did he do that?’

One senior public servant who knew Lord Heywood well told the Bedpan: “There are two conceptions of the neutrality of the civil service. One is that the civil service stands back from the actions of the government of the day and seeks to be some sort of constitutional check on oversteer.

“The alternative conception of the civil service is that you serve with all your heart and all your mind the government of the day. And then when the people elect a different government pursuing different policies, you help them pursue their goals with equal vigour.

Another source reveals that he did indeed think the reforms were “an unmitigated disaster” and would often complain about how hard they made the job of reforming the service in their wake

“And I would say - although there was some sort of underlying intellectual continuity and coherence in Jeremy’s own thinking about the economy and public services – he, for the most part, embodied the second conception of the neutrality of the civil service.”

Lord Darzi remembers that when he came to the Cameron Number 10 to complain about the Lansley reforms, he found the cabinet secretary trying to “neutralise me” by telling him the proposed changes were a “good thing”. However, the Labour peer claims, “I still felt he agreed with me”.

Another source reveals that he did indeed think the reforms were “an unmitigated disaster” and would often complain about how hard they made the job of reforming the service in their wake.

Jeremy Clarke says that – after a brief attraction to the policies of Margaret Thatcher – his friend became “entirely pragmatic” about politics.

He also reveals that of the four PMs Lord Heywood worked for, it was Gordon Brown and Theresa May who impressed him most with their integrity and work rate.

Nick Seddon recalls: “One of the remarkable things about him was that he was a creature of the [civil service] machine, while at the same time being impatient with it. He never gave up [striving to deliver change].”

Mr Seddon adds: “His work rate was legendary – we would joke that there must be holograms or multiple copies of Jeremy wandering around Whitehall.”

Another source remarks on the speed with which he could synthesize issues he had only just been briefed on: “You’d sit in meetings and think ‘holy f***, how did he do that?’”

A deep intellectual curiosity about the NHS

Lord Heywood had to have a wide knowledge across government business, but those who knew him well suggest he had a strong interest in health.

One senior figure who worked closely with him for over a decade says the interest sprang in part – as might be expected – from the size of the NHS budget and importance of the service to his bosses. But it also reflected, they say, “a deep intellectual curiosity about the complexity of the NHS, what it represents for the country as an institution, and as a place where science meets a public and human service”.

As such, this source remarks on the late cabinet secretary’s interest in how the service could be “future proofed” through the introduction of new service models, how the NHS compared to other health services and “a real fascination with the move towards precision medicine”.

That is not to say that the NHS did not cause him headaches. Jeremy Clarke says that as someone “keen on reform and efficiency”, his friend often found the service’s reluctance to consider radical change maddening.

Another Bedpan source remembers someone “very frustrated” with “the anti-business mindset of the Department of Health”, but equally despairing of the defensive nature of many of the large corporations which trade with the service.

They also recall the former cabinet secretary was bemused about the “Groundhog Day” of winter pressures and the lack of a logical “system of consequence” in the service which might see good leaders let go while poor ones survived.

Command and control

Lord Darzi remembers someone who scratched his head about the NHS’s poor use of its estate. “He constantly used to remind me that the London NHS estate was three times the size of Hyde Park,” says the former Labour minister.

Lord Heywood was, claims Mr Clarke, very clear that there were times when a “command and control approach with a ring-fenced budget is what you need”, but that his natural inclination was towards giving patients the information and power to drive improvement.

Partly as a result, he tended to take the claims of the various medical professions with “a pinch of salt”, as he was inherently distrustful of “vested interests”.

The most unstuffy person you could meet

Everyone Bedpan spoke to remarked on Lord Heywood’s generosity with his time and peerless ability to get on with people even when all hell was breaking loose.

“He was incredibly calm, but nevertheless unrelenting when circumstances demanded it,” says Simon Stevens. “He had a fantastic array of direct personal relationships with hundreds, probably thousands, of individuals, and an extraordinary ability to dive into a topic, while keeping another 10 or 20 balls in the air.”

The NHS England chief, who says he has “benefited hugely from my personal relationship with Jeremy”, remembers that “the other defining attribute of Jeremy was his humility. Jeremy was the absolute antithesis of self-importance, he was incredibly down to earth – willing to kind of take the mickey out of himself despite the power he undoubtedly wielded.”

Jeremy Clarke calls his friend “the most unstuffy person you could meet”.

Home truths

And a characteristic which emerged strongly during his last days was – says a close colleague – “a steely lack of self-pity”.

Lord Heywood was nearly always able to prevent personality clashes or policy differences exploding into major problems. One Bedpan source who was there at the time remembers him mediating between the Blair and Brown camps to secure a compromise on the economic freedoms of foundation trusts.

More than a decade later, and with relations between the new PM Theresa May and Mr Stevens at the rockiest, it was Lord Heywood who took much of the heat out of the argument by explaining the NHS England chief was simply delivering some home truths about the state of the NHS.

He was also very good company.

A Bedpan source fondly remembers dinners at which Lord Heywood would be “incredibly indiscreet about the foibles and biases of many very powerful people in central government”.

Nick Seddon says simply: “I loved working with him, he was exacting but he engendered loyalty and affection because you knew he cared.”